Haemorrhagic shock and encephalopathy syndrome: neurological course and predictors of outcome

Abstract

The central nervous system appeared to be the main target of the HSES lesions. The most common outcome was brain death or severe brain damage. Further studies with a larger sample are necessary to determine whether the prognostic indicators we identified are reliable.

Redistribution of Cerebral Blood Flow during Severe Hypovolemia and Reperfusion in a Sheep Model: Critical Role of α1-Adrenergic Signaling

“…Our results point out that maintenance of cortical CBF is essential in managing the bleeding patient to improve neurological outcome [6,7,9]. Moreover, our results emphasize that oxygen supply after hemorrhage may protect the brain from hypoxia as ventilation with 100% oxygen during controlled hypovolemia maintained oxygen saturation of the blood.…”

“…The insufficient protection of cortical CBF during hypovolemia may contribute to the higher vulnerability of the cerebral cortex to ischemic brain damage during hemorrhage [7,9]. Our results point out that maintenance of cortical CBF is essential in managing the bleeding patient to improve neurological outcome [6,7,9].…”

“…It is known that the degree of the decrease of cerebral perfusion is correlated to the severity of brain damage [3]. Taken together, less pronounced redistribution may explain the higher frequency of hypoxic-ischemic brain damage in the cortex as compared to the subcortex of patients with hemorrhagic shock [7,9,10,11,12]. …”

“…The long-term functional outcome is largely determined by the degree of brain damage resulting from shock-associated cerebral hypoperfusion [6,7]. Although redistribution mechanisms maintain cerebral perfusion constant over a wide range of reduced blood pressures [8], this centralization of the circulation under shock conditions does not effectively prevent from cerebral injury [9]. The cerebral cortex appears to be the most vulnerable brain structure under severe shock conditions [7,9].…”

“…Although redistribution mechanisms maintain cerebral perfusion constant over a wide range of reduced blood pressures [8], this centralization of the circulation under shock conditions does not effectively prevent from cerebral injury [9]. The cerebral cortex appears to be the most vulnerable brain structure under severe shock conditions [7,9]. The origin of this vulnerability remains unclear.…”